NEW YORKWho will watch over the burgeoning numbers of cancer survivors and provide the surveillance, general medical care, education, and psycho-social support that the upwards of 10 million survivors in America need and demand? Pilot programs and survivorship care guidelines may be shifting some responsibilities away from oncologists, according to Paul F. Engstrom, MD, medical director of the Fox Chase Cancer Center Partners, and Mary McCabe, RN, MA, director of the Cancer Survivorship Program at Memorial Sloan-Kettering Cancer Center, who spoke at the Second Annual Oncology Congress.
"Some 64% of our patients survive more than 5 years, so we must look past the acute management of the illness," Dr. Engstrom said. "And 75% of oncologists provide some or all of the health maintenance and preventive services for their patients past the acute management period." He noted that there is much to watch out for: recurrent disease, second primary tumors, fatigue, complications of treatment such as "chemo brain," cardiac problems, osteoporosis, fertility and reproductive problems, as well as psychosocial and genetic issues.
The growing numbers of cancer survivors and the complexity of their care suggests to many that the continuum of care has to change. Ms. McCabe said the time has come "to begin to pilot how we are going to work among specialties in this country. We have to think about where we want to go in terms of quality care and what that means." Memorial Sloan-Kettering is among seven cancer centers that are piloting different models of survivorship care, in conjunction with the Lance Armstrong Foundation.
All models, she explained, are built on a risk-stratified approach, understanding of respective roles, clear communication, confidence, and a supportive infrastructure that promotes easy transfer of medical records.
Some look to the pediatric oncology model of long-term follow-up. Many cancer centers have free-standing pediatric oncology follow-up programs with separate teams of nurse practitioners, oncologists, and social workers. "Pediatric oncology is also moving to more risk-based care in terms of who stays within the system and who has a coordinated hand-off back to community physicians," Ms. McCabe said.
Other centers are piloting a consultative model in which the patient has a one-time visit with a nurse practitioner who provides the patient a summary of care and plan for surveillance. The patient is then followed by the treating oncologist.